Dr. Peter M. Sandman Precaution Advocacy (High Hazard, Low Outrage)

I got my start in risk communication – before the phrase was coined – as someone who helped environmental groups arouse public concern about the need for recycling, the dangers of factory emissions, and the like. My earliest publications, most of which are not available on this site or anywhere on the web, dealt with how to design and carry out environmental advocacy campaigns. For a list of these early publications, check out the entries for the 1970s in my C.V.

In the terminology I now use, my focus was on high-hazard low-outrage situations. The job was precaution advocacy: to arouse some healthy outrage and use it to mobilize people to take precautions or demand precautions.

I never abandoned this focus, but starting in the 1980s more of my time was spent on the opposite problem: reducing outrage in low-hazard high-outrage controversies. (See Outrage Management (Low Hazard, High Outrage).) There were two main exceptions.

One exception was work with Neil Weinstein and others on radon. Radon is an odorless, colorless gas and a naturally occurring carcinogen; it accumulates in buildings (especially well insulated buildings) and ends up in the lungs of the residents. When I first got involved in radon communication, authorities were afraid people would panic; Neil and I assured them the dominant problem would be apathy, not panic – and we launched a research program to figure out how to persuade people to test their homes for radon and, if high levels were found, to mitigate the problem.

The other major exception was employee safety. From time to time a client that had first employed me to help figure out how to reduce community outrage about one set of hazards came back for help when employees were ignoring or mishandling a more serious set of hazards. A mining company in Australia, for example, needed to persuade employees to obey safety regulations. The work I had done for environmental activists on arousing outrage was helpful here, but other approaches were needed too – sometimes the problem wasn’t really insufficient employee outrage at the hazard, but rather excessive employee outrage at the precaution: safety rules and safety equipment that chafed. I haven’t done any radon work in a long time, but I continue to consult and write on environmental activism and on risk communication aspects of employee safety.

Much more recently I have become heavily involved in a third venue for precaution advocacy: mobilizing people to take action with regard to infectious disease outbreaks, especially the risk of an influenza pandemic. My writing on pandemic communication is indexed in the “Pandemic Flu and Other Infectious Diseases Index.” But some articles focusing on arousing apathetic audiences are also listed here, while some that focus on helping people cope when the time comes are also listed in the “Crisis Communication Index.”

So the “Precaution Advocacy” articles listed below are derived from four main sources – work with environmental activists from the early 1970s through the present; work on radon communication in the 1980s and 1990s; work on employee safety from the 1990s through the present; and work on pandemic preparedness in the 2000s.

On Precaution Advocacy Generally

Interview with Peter M. Sandman by Marisa Raphael, New York City Department of Health and Mental Hygiene, February 27, 2014

Marisa Raphael is Deputy Commissioner at the Office of Emergency Preparedness and Response of the New York City Department of Health and Mental Hygiene. She is also participating in the National Preparedness Leadership Institute (NPLI) at Harvard University. On February 27, 2014, she interviewed me for an hour by telephone on behalf of an NPLI project on ways to improve emergency preparedness communications with the general public. Although we spent a little time at the end of the interview covering some basics for communicating mid-crisis, we stuck mostly to pre-crisis communication, a kind of precaution advocacy. We covered two main topics. First we talked about why it’s so hard to build citizen support for government emergency preparedness expenditures, and what kind of messaging strategies are likeliest to lead to such support. Then we switched to a more conventional topic: how to motivate people to do their own personal, family, or neighborhood emergency preparedness.

Brooke Gladstone of “On the Media” interviewed me in my home for 49 minutes. We started out talking about claims by opponents of NSA telephone and email surveillance (in the wake of the Edward Snowden leaks) that “more people have died from [whatever] than from terrorism” – and why these sorts of risk comparisons are unlikely to be convincing. That soon got me to the distinction between hazard and outrage. But Brooke didn’t let me do my usual hazard-versus-outrage introductory shtick. Instead, she kept asking for specifics – examples of how precaution advocacy and outrage management strategies work in practice. Toward the end of the interview, she pushed me to shoot from the hip about applications I hadn’t thought through: How would I use risk communication to defend government surveillance? To oppose it? To defend shale gas “fracking”? To oppose that? The interview that resulted is a different sort of introduction to risk communication than the one I usually give. The 10-minute broadcast segment is nicely edited; it’s very smooth and covers most of my main points. But I prefer the roughness and detail of the complete interview.

Familiar risks lose their capacity to provoke outrage, and people get careless. Unfamiliar risks, on the other hand, are likelier to be upsetting. So if you’re doing outrage management – if you’re a factory manager trying to keep your neighbors calm, for example – familiarity is your ally. But if you’re doing precaution advocacy – an activist trying to arouse public concern, or a safety professional trying to motivate employees to wear their hardhats – familiarity is your enemy. Either way, managing familiarity is a significant part of the risk communication job. Those are the basics. But this column goes beyond the basics, getting down in the weeds of managing risk familiarity. It focuses especially on two distinctions: the distinction between familiarity and perceived familiarity (fluency); and the distinction among familiarity with the overall situation, familiarity with the risk, and familiarity with the bad outcome (memorability).

The need to simplify technical content is not an acceptable excuse for “simplifying out” information that is essential to credibility – especially information that seems to contradict your message, and that will therefore undermine your credibility if you leave it out and your audience learns it elsewhere. The obligation to include that sort of information is called the communicative accuracy standard; the failure to include it might appropriately be called “misoversimplification.” The column distinguishes three levels of misoversimplification, depending partly on how controversial the issue is and partly on whether you’re on the warning (precaution advocacy) or reassuring (outrage management) side. The three levels are illustrated with infectious disease examples: whooping cough, bird flu, and polio.

The audience of precaution advocacy messages is quite likely to be apathetic, to find the information (safety information, for example) boring. This column outlines the only four ways I know to get people to learn risk information or any information. The first answer, learning without involvement, requires more budget than precaution advocacy campaigns usually have. The second answer, interest/entertainment, is also tough to achieve, though it’s always worth trying. So the column focuses mostly on the remaining two options. Giving people a “need to know,” such as a pending decision that requires the information, is a powerful tool of precaution advocacy. Also powerful, and psychologically much more complex, is getting people to see the information as ammunition – for example, motivating them to do something they’ve never done before, and then offering the information as a rationale that helps them makes sense of the new behavior.

Together with my wife and colleague Jody Lanard, I have long advised clients to release risk information early – and since early information is almost always uncertain, to acknowledge the uncertainty. But even when clients (and non-clients) do what we consider a pretty decent job of acknowledging uncertainty, they often end up in reputational trouble when they turn out wrong, largely because journalists and the public misperceive and misremember their statements as having been far more confident than they actually were. So we have come to believe that it’s not enough to acknowledge uncertainty; you have to proclaim uncertainty, repeatedly and emphatically. This long column uses a severe German E. coli food poisoning outbreak in 2011 to explore the complexities of proclaiming uncertainty: the myriad ways government agencies and industry spokespeople get it wrong, and some recommendations for getting it right … or at least righter. Proclaiming uncertainty is important in all kinds of risk communication – outrage management as much as precaution advocacy and crisis communication. But our focus here is mostly on how to warn people about an imminent, uncertain risk: in this case, how to tell people which foods not to eat because you think they might be contaminated and deadly.

I speak and write endlessly about ways to increase people’s outrage when you think they’re insufficiently upset about a serious risk and ways to decrease their outrage when you think they’re excessively upset about a not-so-serious risk. I call these two kinds of risk communication “precaution advocacy” and “outrage management” respectively. This column makes a point I too often forget to mention: Except in emergencies (real or imagined), it’s impossible to get people more or less outraged. Mostly what we do is reallocate their outrage. The column calls this “the Law of Conservation of Outrage,” and discusses six corollaries that are fundamental to risk communication: the natural state of humankind vis-à-vis any specific risk is apathy; outrage is a competition; there’s no reason to worry about turning people into scaredy-cats; if people are more outraged at you than the situation justifies, you’re doing something wrong; excessive outrage aimed at you isn’t your critics’ fault; and outrage causes hazard perception – and we know what causes outrage.

Presented to the National Public Health Information Coalition, Miami Beach FL, October 21, 2009
Posted: January 2, 2010

Although this six-hour seminar was entitled “Three Paradigms of Radiological Risk Communication,” NPHIC asked me to go easy on the “radiological” part and give participants a broad introduction to my approach to risk communication, mentioning radiation issues from time to time. So that’s what I did.

Fair warning: These are not professional videos. NPHIC member Joe Rebele put a camera in the back of the room and let it run. You won’t lose much listening to the MP3 audio files on this site instead.

Part 1 (90-min.)

Part One is a introduction to the hazard-versus-outrage distinction and the three paradigms of risk communication.

Part Two discusses the seesaw and other risk communication games (thus completing the introductory segment), then spends a little over an hour each on some key strategies of precaution advocacy and outrage management.

The Precaution Adoption Process Model (PAPM) was developed mostly by Neil Weinstein, with some help from me. It is an attempt to identify the stages people must pass through on the way to adopting a new precaution: unaware, uninvolved, undecided, decided to act, acting, and maintaining action. It also tries to identify the interventions most likely to move people from one stage to the next. This 2008 book chapter summarizes the PAPM – how it differs from non-stage theories and competing stage theories of health-protective behavior; the justification for the stages specified; the advantages of stage-matched interventions; research testing the PAPM and research using it; etc. Two earlier articles applying the PAPM to a specific example, radon risk, are also on this website: “A Model of the Precaution Adoption Process: Evidence From Home Radon Testing” and “Experimental Evidence for Stages of Health Behavior Change: The Precaution Adoption Process Model Applied to Home Radon Testing.” This chapter is a better introduction: more recent, broader, and less quantitative.

This column is a primer on precaution advocacy – that is, on high-hazard low-outrage risk communication, where the job is to increase outrage and thus to motivate apathetic people to take precautions (or demand precautions). Apathy isn’t always the problem when people are ignoring a serious risk – they could be in denial, for example, or they could have reasons to dislike the recommended precautions. But when apathy is the problem, this column is a good place to start. It’s a quick rundown on twenty precaution advocacy basic principles.

In February 2005, the New York City health department issued a warning about a possibly disastrous new strain of AIDS. It was widely criticized for alarming people before it had solid evidence that the strain was spreading. Also in February 2005, the United Kingdom’s Food Safety Authority held off announcing that many prepared foods were contaminated with tiny amounts of the banned red dye Sudan 1, because it wanted to prepare a list of affected products first. It was widely criticized for the delay. Obviously, when to release risk information is a tough call. In this column, Jody Lanard and I lay out the pros and cons, and conclude that early is almost always better than late. We also analyze the New York City decision in detail, and offer some ways to reduce the downsides of early release.

Most of this long column is addressed to risk communicators whose goal is to keep their audience unconcerned. So naturally they’d rather not talk about awful but unlikely worst case scenarios. The column details their reluctance even to mention worst case scenarios, and their tendency when they finally get around to discussing them to do so over-reassuringly. It explains why this is unwise – why people (especially outraged people) tend to overreact to worst case scenarios when the available information is scanty or over-reassuring. Then the column lists 25 guidelines for explaining worst case scenarios properly. Finally, a postscript addresses the opposite problem. Suppose you’re not trying to reassure people about worst case scenarios; you’re trying to warn them. How can you do that more effectively?

When you think people are under-reacting to a risk, the usual diagnosis is “apathy” and the usual prescription is some sort of precaution advocacy: “This could kill you! Here’s how to protect yourself.” This short column is a checklist of questions to consider – in sequence – before jumping to the conclusion that apathy is the right diagnosis and precaution advocacy is the right prescription. Some of the alternatives (not paying attention, for example) are very familiar to safety professionals. Others (such as problems with self-efficacy and fatalism) are often missed.

The experiment reported in this article deals with ways of depicting risk when you’re trying to get people to realize how serious the risk is ... or how serious it isn’t. In other words, how do you explain risk data so your audience will neither underestimate nor overestimate seriousness? The study shows some strategies that help, even in the face of outrage. The study also documents – for readers who need it documented – that outrage does make people consider a risk more serious.

This 1986 article aimed at helping peace activists develop communication strategies that wouldn’t deepen people’s “psychic numbing” about nuclear weapons. Though its political content is out of date, its prescription – anger, love, hope, and action – is relevant today to coping with public denial about terrorism. (For terrorism I would want to add to the prescription the need to acknowledge and share the underlying fears – what people are “really” afraid of.)

This discussion of how the media influence their audience and how doctors can influence the media was written 25 years ago – before managed care and before cable. Despite the outdated specifics about both medicine and media, the principles have held up well. This is still a pretty good primer on media impact and how to horn in.

On Environmental Activism

This short editorial from “the newspaper for the UK grassroots peace and justice movement” draws heavily on “Scared stiff – or scared into action,” an article I coauthored with JoAnn M. Valenti and published in the January 1986 issue of the Bulletin of the Atomic Scientists. That article focused on the ways in which activists opposing nuclear weapons might be frightening people into numbness, paralysis, or denial instead of inspiring them to join the cause. The Rai and Johns editorial applies some of our points to climate change activism, noting that “the disciplines of risk communication and disaster psychology may help us [climate change campaigners] to think new thoughts, and find new ways forward.” I have also written about this connection, in a 2009 column on “Climate Change Risk Communication: The Problem of Psychological Denial.”

Interview with Peter M. Sandman by Marco Werman, aired on “The World” on PRI (Public Radio International) and posted on its website, September 27, 2013

When the Intergovernmental Panel on Climate Change released its new report – claiming more certainty than ever before that the global warming threat is dire – Marco Werman of PRI’s “The World” interviewed me about why I thought many people might find the report’s conclusions hard to accept, and might go into a kind of psychological denial instead. The interview lasted about ten minutes, but was cut to less than five for airing. I made too many minor points that got used, albeit in abbreviated form. So my main point got almost completely lost – that climate change activists were their own worst enemies because they kept saying things that were likely to provoke or deepen people’s denial instead of things that could help people overcome their denial. For example, I told Marco, too many environmentalists were greeting the IPCC’s bad news triumphantly, almost gleefully – sounding more pleased that they were being proved right than devastated that the world’s in deep trouble. People who like their SUVs and are having a hard time accepting that they may have to give up their SUVs (that’s a kind of denial) may just barely be able to believe it if a fellow SUV fan sadly tells them so. They’re not about to believe it if it’s exultantly announced by someone who has hated the internal combustion engine since before global climate change was even an issue. For several better explanations of my thinking about climate change denial, see any of the other entries with “climate” and/or “denial” in their titles in the “On Environmental Activism” section of my Precaution Advocacy index.

This was a 48-minute telephone interview with Stephen Dubner, for a Freakonomics Radio program (and podcast) on climate change. The interview never made it into the program/podcast, but excerpts were added to the Freakonomics website on November 29, 2011. The first 17 minutes of the interview are generic – Risk Communication 101, basically. The rest is grounded mostly in my 2009 column on “Climate Change Risk Communication: The Problem of Psychological Denial,” though Dubner periodically pushed me to speculate on new aspects of the topic. My main argument: Climate change risk communicators are good at informing and scaring apathetic people, but need an entirely different strategy – something more like outrage management – for people who are in denial about climate change.

Excerpts from the RISKANAL listserv, March 24–25, 2009 (plus some follow-up offline correspondence)

In late March of 2009, discussion on the RISKANAL (risk analysis) listserv turned to the psychology of people – including people on the listserv – who are skeptical about global climate change. I had recently dealt with this question in a column for this website on “Climate Change Risk Communication: The Problem of Psychological Denial.” So I posted a comment on the listserv referencing and summarizing the column. The resulting brief dialogue dealt with the motives not just of global warming skeptics but also of global warming supporters. And it led to a further discussion of whether strategic persuasion (on behalf of global warming or any topic) is antithetical to sincerity. I thought it was a good, thoughtful and respectful discussion – worth reprinting here (with the permission of all the participants). After the RISKANAL discussion petered out, I continued to exchange emails (also posted here) with one participant in the dialogue, Stephen L. Brown. Our focus slowly shifted from climate change risk communication to outrage and outrage management – and led to some observations on Steve’s part about outrage that I think are well worth reading, whether you’re interested in global warming or not.

Arousing apathetic people to care enough about global warming that they’re actually willing to do something about it is a difficult precaution advocacy challenge. Activists are chipping away at that task with slow but significant success. But there’s another audience for climate change risk communication that I think activists aren’t paying nearly enough attention to: people who are in denial about the crisis because it threatens the way they see the world or because it arouses intolerable levels of fear, guilt, sadness, hopelessness, or other emotions. For people in or near denial, outrage is high, not low; the risk communication paradigm is crisis communication, not precaution advocacy. This long column builds a case that global warming denial is a growing problem, and that messaging designed to work on apathetic audiences can easily backfire on audiences in denial. The column focuses on six common activist messages that need to be rethought in terms of their likely negative impact on people who are in or near global warming denial: fear-mongering; guilt-tripping; excessive hostility to narrow technological solutions; unwillingness to pay attention to climate change adaptation; over-reliance on depressing information and imagery; and one-sided contempt for contrarian arguments.

Denial near and far

Broadcast on PRI’s “The World,” November 21, 2008

Radio reporter Jason Margolis of “The World” attended a conference of global climate change skeptics, decided they were more deniers than actual skeptics, and ended up with a 10-minute story on climate change denial. I was one of several experts he quoted to explore the reasons why so many people have trouble facing the threat of global warming. In our interview, I focused on some ways activist communications may unwittingly encourage audience denial. Jason used the part on guilt – on why telling people their lifestyle is destroying the earth may not be the best way to inspire them to action. My views are elaborated further in a 2009 column on “Climate Change Risk Communication: The Problem of Psychological Denial.”

Brian Day was my graduate student before going on to do communications for Environmental Defense Fund, GreenCOM, and other environmental advocacy efforts. In this chapter from a book he co-edited with Martha Monroe, Brian outlines a persuasion theory I taught him back in the 1970s – an approach to precaution advocacy that uses both an information-based component and a need-based component.

This is one of two articles I have posted dealing with the Precaution Adoption Process Model, developed mostly by Neil Weinstein and tested by Neil and me (and colleagues) using radon as the test case. The other article, A Model of the Precaution Adoption Process: Evidence From Home Radon Testing, is statistically heavier going and methodologically less rigorous, but covers more ground: It says more about how people decide to test their homes for radon, and contains a more detailed description of the model itself. This one has more convincing evidence that people decide to take precautions – in this case to test for radon – in stages, and that different interventions work best at different stages. See also The Precaution Adoption Process Model,” a 2008 book chapter that overviews the PAPM more generally.

For about a decade, Neil Weinstein and I (with colleagues) did research on radon – a high-hazard low-outrage risk that first became important in the mid-1980s. This article uses several of our radon data sets to illustrate Neil’s Precaution Adoption Process Model (PAPM). The PAPM is one of several contending models of how people actually decide whether or not to protect themselves from risks. Different models lead to different interventions, so the competition over which model best explains people’s behavior is important for those trying to persuade publics to take precautions about serious hazards.

Most of the research on radon risk response – mine as well as others’ – has focused on how to persuade people to test. This article shows that even after people have tested and found a high radon level, persuading them to do something about the problem isn’t easy ... and mere information isn’t what does the trick. When this research was done, radon was a new issue; the findings reported here may be more useful for those working on other new issues than for those working on the now-familiar radon problem.

On Employee Safety

When you do something that might have caused an accident but doesn’t, there are two ways to interpret the near miss: as a warning that you should be more careful, or as evidence that the behavior in question is actually pretty safe. Safety professionals tend toward the first interpretation; everybody else favors the second. This column discusses several factors that affect near miss perception: hindsight bias, the gambler’s fallacy, learned overconfidence, “resilient near misses” versus “vulnerable near misses,” and vividness. It hypothesizes that a crucial distinction is whether you know the behavior in question often causes an accident (so you see the near miss as a warning) or you don’t know how dangerous the behavior is (so you see the near miss as evidence the risk is low). The column ends with advice for safety communicators trying to use near misses as warnings.

I started my career doing what I now call “precaution advocacy,” helping activist groups figure out how to arouse environmental concern in apathetic publics. But the bulk of my corporate consulting over the past 40 years has focused instead on “outrage management,” figuring out how to calm people who are excessively concerned. Most of my outrage management clients have never asked my advice on precaution advocacy, not even in its most obviously relevant manifestation: improving worker safety. This column addresses seven sorts of safety problems, and outlines where I think risk communication can help with each. I’m particularly interested in the last of the seven: whether my signature concept of outrage might conceivably be the next new thing in occupational safety.

Tough economic times are tough on safety. Workers may be distracted or distressed, while safety budgets (like all budgets) may be reduced. Tough economic times are also tough on safety controversies. Not only do workers have real reasons to suspect that they might be more endangered than usual; they also have less patience and forbearance, and perhaps more motivation to project their economic worries onto an on-the-job safety situation. This short column for industrial hygienists offers some tips on ways to adjust safety risk communication when the economic situation is bad.

I have long been interested in why corporate managements reject safety improvements that look eminently cost-effective – in some cases, improvements that have a better return-on-investment than the company’s principal product line. This short column explores some outrage-grounded reasons why senior managers might shy away from sensible safety investments. Among them: guilt/responsibility, ego/stature, hostility/contempt, fear/denial, and performance anxiety. The column suggests some ways safety professionals can break the logjam when factors like these are keeping their companies from making safety progress.

I have long argued that corporate environmental performance is better “sold” to stakeholders as a response to pressure than as a self-motivated commitment to the environment; I think claiming to be responsive is both truer and more credible than claiming to be responsible. In this article I make the same case about “selling” safety to employees. When management says it cares more about safety than productivity or profit, I argue, employees are likely to conclude that safety rules have more to do with company PR than company policy, and may “loyally” rather than rebelliously disobey. The article also discusses why both safety professionals and top corporate managers enjoy making a values case for safety, and resist making the business case I think they should make.

Employees may resist wearing personal protective equipment (PPE) for all sorts of reasons: It’s uncomfortable; it interferes with productivity; it’s not the macho thing to do; management doesn’t really mean it; the safety person’s warnings sound a lot like my mother. This article discusses some of my ideas about how to be convincing in the face of these reasons.

Jody Lanard and I wrote “Duct Tape Risk Communication” to analyze the weird public response to the U.S. Government advice to stockpile duct tape for use against some kinds of terrorist attacks. Dave Johnson saw an analogy to the weird way employees sometimes respond to safety messaging, and went with it.

This interview focuses on the “other side” of risk communication – how to persuade people to take risk more seriously. It deals mostly with two problems: employees who ignore safety procedures even though they have been well trained, and employers who ignore safety opportunities even though they are cost-effective. Both problems have their roots in outrage.

On Infectious Diseases and Pandemic Preparedness

I wrote this short column in early June 2009 for The Synergist, a magazine for industrial hygienists, on some ways of communicating about flu – seasonal and pandemic – in the workplace. When I wrote it, most people had “recovered” from what they considered the spring “swine flu scare,” and they were in no mood to listen to any more influenza warnings. By the time the column was published in September 2009, some of the complacency had waned, and people were actually girding up (a bit) for another wave of mild-but-pervasive pandemic illness. So the column’s claim that flu preparedness is a tough sell needs to be modified somewhat. But its actual recommendations still stand.

Convincing health care workers to get a flu shot might normally be seen as a straightforward problem in precaution advocacy, but this column focuses on an aspect of the problem that’s grounded in outrage management: flu protection hype. By means of three case studies, Jody Lanard and I document that hype – misleading, one-sided messaging on behalf of vaccination and other flu precautions – does in fact characterize much of what’s produced by flu prevention campaigners. We also argue, with much less evidence, that the hype leads health care workers to mistrust what the campaigners are telling them, and that the mistrust probably reduces their willingness to get vaccinated. The column ends with a list of less tendentious recommendations for convincing health care workers to get a flu shot.

Published in U.S. News and World Report, November 21, 2005; online November 13, 2005

This is an excellent summary of the dilemma authorities face when trying to alert the public to the risk of pandemic flu – a risk that could be severe or mild, imminent or far into the future. Despite its title, the article does point out that the risk of inciting panic isn’t a major problem, although the (unjustified) fear of inciting panic is. It offers justified praise to the U.S. government and the World Health Organization for their increasing willingness to sound the alarm.

PAHO asked us to combine a primer on risk communication with a primer on avian influenza. The resulting article talks about the challenge of alerting the public to bird flu risks, then offers ten risk communication principles, each illustrated with bird flu examples. The PDF file also includes the cover, an editor’s note entitled “Communication: risky business,” and the contents page.
(Note the confusion of “bird flu” with pandemic flu in this 2005 article – and this blurb, also written in 2005.)

(There is an online version (same text, but easier to read than a PDF file) posted on the PAHO website. The entire issue is also there.

Spanish translation available

This is the first column Jody Lanard and I wrote about pandemic preparedness. We wrote it when many experts believed a devastating H5N1 flu pandemic might be just around the corner – and so we thought so too. (We still think the risk is serious, but there’s much less sense of imminence as I write this blurb in mid-2008.) The thrust of this long column is how to sound the alarm. After a primer on why H5N1 is “not your garden variety flu,” the column proposes a list of pre-crisis pandemic talking points. Then it assesses how well experts and officials were addressing those points as of late 2004. The experts, we wrote, were doing their best to arouse the public. But governments and international agencies were undermining the sense of urgency with grossly over-optimistic claims about pharmaceutical solutions.